Hepatic carcinoma with indolent T-lymphoblastic proliferation (iT-LBP)

Although indolent T-lymphoblastic proliferation (iT-LBP) in the extrathymic location have been shown to be a distinct clinicopathologic entity, carcinoma composed iT-LBP are rare. We retrospectively analyzed the clinicopathological features of 7 hepatic carcinoma cases with iT-LBP. There were 5 male and 2 female patients, aged from 37-54 (mean 47) years. All patients had a clinical history of chronic hepatitis B viral infection with high serum AFP level. Microscopically, these carcinomas were characterized by admixed with increased amounts of fibrous and small lymphocytes composed of regressive germinal centers. Immunohistochemically, in lymphoid tissues, some TDT⁺ cells were highlighted in the CD3+ area. These lymphoblasts localized predominantly between the cords of the carcinoma and interfollicular regions, diffused or only focal presented more than 50 TdT⁺ lymphoblasts/HPF. No EBV infection cells and T-cell antigen clonal rearrangement was detected. 3/4 cirrhotic patients developed HCC recurrence, while the 4-y survival rate was 100% in non-cirrhosis patients. It-LBP is a rare unusual proliferation and easily be misdiagnosed in HC patients. It does not seem to be associated with a specific HCC type. If HC companied with numerous small lymphocytes infiltration and showed high Ki67 index, a primary HC with iT-LBP should be considered in the lists of diagnosis.